LEONARDO ZUMERKORN PIPEK
Projetos de Pesquisa
Unidades Organizacionais
Instituto Central, Hospital das Clínicas, Faculdade de Medicina
LIM/09 - Laboratório de Pneumologia, Hospital das Clínicas, Faculdade de Medicina
LIM/09 - Laboratório de Pneumologia, Hospital das Clínicas, Faculdade de Medicina
13 resultados
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- Long-term outcomes of ruptured saccular intracranial aneurysm clipping versus coiling: systematic review and meta-analysis of randomized controlled trials(2022) RABELO, Nicollas Nunes; TELLES, Joao Paulo Mota; PIPEK, Leonardo Zumerkorn; MAKAREM, Louise; BOECHAT, Antonio Luis; TEIXEIRA, Manoel Jacobsen; FIGUEIREDO, Eberval GadelhaIntroduction Previous meta-analyses comparing microsurgery and coiling that include BRAT may be inaccurate to compare the outcomes of ruptured saccular aneurysms. This study aims to evaluate 10-year efficiency, safety, and advantages of coiling compared with clipping in patients with spontaneous saccular aneurismal SAH as a primary outcome. Also analyzed secondary outcomes: no-occlusion, mortality, rebleeding, and retreatment. Methods A systematic search of the literature on microsurgical clipping versus coiling was done to identify RCTs with at least 10 years of follow-up published between 2000 and 2021. The primary outcome was favorable functional outcome, defined as a modified Rankin scale (mRS) score <= 2. Secondary outcomes were no-occlusion, mortality, rebleeding, and retreatment. Quality of the included trials was analyzed using the Risk of Bias 2.0 (RoB 2.0) tool. A random-effects meta-analysis was performed. Results Two studies reported 10-year follow-up results, and the meta-analysis did not demonstrate significant differences between groups (OR 0.9, 95%CI 0.66-1.24, I-2 = 21%). No differences were observed compared clipping and coiling regarding occlusion rates (OR 5.3, 95%CI 0.8-36.3, I-2 = 89%). Mortality rates did not show significant differences between treatment modalities (OR 0.97, 95%CI 0.77-1.21, I-2 = 0%). Rebleeding rates were also similar between groups (OR 1.63, 95%CI 0.25-10.7, h= 37%); however, significantly higher retreatment rates were associated with coiling (OR 10.6, 95%CI 2.1-52.5, I-2 = 80%). Overall, risk of bias was low. Conclusion There are no long-term differences regarding no-occlusion, mortality, and rebleeding rates between coiling and clipping. Higher retreatment rates were associated with coiling.
- Homocysteine is associated with higher risks of ischemic stroke: A systematic review and meta-analysis(2022) RABELO, Nicollas Nunes; TELLES, Joao Paulo Mota; PIPEK, Leonardo Zumerkorn; NASCIMENTO, Rafaela Farias Vidigal; GUSMAO, Rodrigo Coimbra de; TEIXEIRA, Manoel Jacobsen; FIGUEIREDO, Eberval GadelhaBackground High levels of homocysteine (Hct) have been associated with great risks of ischemic stroke. However, some controversy still exists. We performed a systematic review and meta-analysis to compare the levels of Hct between patients with ischemic stroke and controls. Methods We performed a systematic literature search for articles reporting Hct levels of patients with occurrence of ischemic stroke. We employed a random-effects inverse-variance weighted meta-analytical approach in order to pool standardized mean differences, with estimation of tau(2) through the DerSimonian-Laird method. Results The initial search yielded 1361 studies. After careful analysis of abstracts and full texts, the meta-analysis included data from 38 studies, which involved almost 16 000 stroke events. However, only 13 studies reported means and standard deviations for cases and controls, and therefore were used in the meta-analysis. Those studies presented data from 5002 patients with stroke and 4945 controls. Standardized mean difference was 1.67 (95% CI 1.00-2.25, P < 0.01), indicating that Hct levels were significantly larger in patients with ischemic stroke compared to controls. Between-study heterogeneity was very large (I-2 = 99%), particularly because three studies showed significantly large mean differences. Conclusion This meta-analysis shows that patients with ischemic stroke have higher levels of Hct compared to controls. Whether this is a modifiable risk factor remains to be assessed through larger prospective cohorts.
- Could outcomes of intracranial aneurysms be better predict using serum creatinine and glomerular filtration rate?(2022) RABELO, Nicollas Nunes; PIPEK, Leonardo Zumerkorn; NASCIMENTO, Rafaela Farias Vidigal; TELLES, Joao Paulo Mota; BARBATO, Natalia Camargo; COELHO, Antonio Carlos Samaia da Silva; BARBOSA, Guilherme Bitencourt; YOSHIKAWA, Marcia Harumy; TEIXEIRA, Manoel Jacobsen; FIGUEIREDO, Eberval GadelhaPurpose: To analyze the role of serum creatinine levels as a biomarker of intracranial aneurysm outcomes. Methods: This is a prospective analysis of outcomes of patients with intracranial aneurysm. One hundred forty-seven patients with serum creatinine at admission and 6 months follow up were included. Linear and logistic regressions were used to analyze the data. Modified Rankin scale (mRS) was used to assess outcome. Results: Creatinine level was not directly related to aneurysm outcome nor aneurysm rupture (p > 0.05). However, patients with a glomerular filtration rate (GFR) lower than 72.50 mL.min(-1) had an odds ratio (OR) of 3.049 (p = 0.006) for worse outcome. Similarly, aneurysm rupture had an OR of 2.957 (p = 0.014) for worse outcomes. Stepwise selection model selected 4 variables for outcomes prediction: serum creatinine, sex, hypertension and treatment. Hypertensive patients had, on average, an increase in 0.588 in mRS (p = 0.022), while treatment with microsurgery had a decrease in 0.555 (p = 0.038). Conclusion: Patients with higher GFR had better outcomes after 6 months. Patients with higher GFR had better outcomes after 6 months. Creatinine presented an indirect role in GFR values and should be included in models for outcome prediction.
- New perspectives on assessment and understanding of the patient with cranial bone defect: a morphometric and cerebral radiodensity assessment(2024) OLIVEIRA, Arthur Maynart Pereira; ANDRADE, Almir Ferreira De; PIPEK, Leonardo Zumerkorn; IACCARINO, Corrado; RUBIANO, Andres M.; AMORIM, Robson Luis; TEIXEIRA, Manoel Jacobsen; PAIVA, Wellingson SilvaBackground Skull defects after decompressive craniectomy (DC) cause physiological changes in brain function and patients can have neurologic symptoms after the surgery. The objective of this study is to evaluate whether there are morphometric changes in the cortical surface and radiodensity of brain tissue in patients undergoing cranioplasty and whether those variables are correlated with neurological prognosis.Methods This is a prospective cohort with 30 patients who were submitted to cranioplasty and followed for 6 months. Patients underwent simple head CT before and after cranioplasty for morphometric and cerebral radiodensity assessment. A complete neurological exam with Mini-Mental State Examination (MMSE), modified Rankin Scale, and the Barthel Index was performed to assess neurological prognosis.Results There was an improvement in all symptoms of the syndrome of the trephined, specifically for headache (p = 0.004) and intolerance changing head position (p = 0.016). Muscle strength contralateral to bone defect side also improved (p = 0.02). Midline shift of intracranial structures decreased after surgery (p = 0.004). The Anterior Distance Difference (ADif) and Posterior Distance Difference (PDif) were used to assess morphometric changes and varied significantly after surgery. PDif was weakly correlated with MMSE (p = 0.03; r = -0.4) and Barthel index (p = 0.035; r = -0.39). The ratio between the radiodensities of gray matter and white matter (GWR) was used to assess cerebral radiodensity and was also correlated with MMSE (p = 0.041; r = -0.37).Conclusion Morphological anatomy and radiodensity of the cerebral cortex can be used as a tool to assess neurological prognosis after DC.
- Prospective Analysis of Cerebral Edema Admission and Clinical Outcome in Ruptured Intracranial Aneurysm(2023) OBERMAN, Dan Zimelewicz; RABELO, Nicollas Nunes; PIPEK, Leonardo Zumerkorn; TELLES, Joao Paulo Mota; BARBAT, Natalia Camargo; COELHO, Antonio Carlos Samaia da S. I. L. V. A.; YOSHIKAWA, Marcia Harumy; BARBOSA, Guilherme Bittencourt; TEIXEIRA, Manoel Jacobsen; FIGUEIREDO, Eberval GadelhaAIM: To evaluate the association between global cerebral edema (GCE) after subarachnoid hemorrhage (SAH) and its impact on functional outcome evaluated by the modified Rankin scale (mRS). MATERIAL and METHODS: This is a prospective cohort study with patients who were admitted to the hospital due to SAH. During the period from January 2018 to November 2019, 107 patients with intracranial aneurysms were enrolled. Using univariate and multivariate analysis, we sought to identify predictors and evaluated the impact of GCE on outcome after 6 months using the mRS. RESULTS: GCE was present in 54 (50.5%) patients, of which 27 (25.2%) were mild, 20 (18.7%) moderate and 7 (6.5%) were severe. Univariate analysis identified high Hunt-Hess and Glasgow coma scale on clinical admission as predictors factors of GCE (p<0.05), and higher modified Fisher scale as a radiological predictor of Glasgow coma scale (p<0.05). Thirty-three (30.8%) patients were deceased at 6 months. Death or severe disability were predicted by higher age, poor clinical scale on admission and severe GCE (p<0.05). CONCLUSION: GCE on admission is independently associated with poor clinical outcomes at discharge, and six months after SAH. Given its strong association with poor clinical grade on admission, GCE should be considered a straightforward and radiological important marker of early brain injury, with ominous implications.
- Inflammatory markers assessment in an animal model of intracranial hypertension: a randomized trial(2021) SANTO, Marcelo Prudente do Espirito; FARIA, Caroline Silverio; SOLLA, Davi Jorge Fontoura; PIPEK, Leonardo Zumerkorn; BELON, Alessandro Rodrigo; JENG, Brasil Ping; ANDRADE, Almir Ferreira de; TEIXEIRA, Manoel Jacobsen; PAIVA, Wellingson SilvaBackground: Intracranial hypertension (ICH) is a common final pathway of most neurosurgical pathologies and leads to poor prognosis if not detected and treated properly. Inflammatory markers have been assessed in clinical scenarios of neurological injuries, in which systemic and brain tissue aggressions may introduce bias. There is a lack of studies under controlled settings to isolate the ICH effect on inflammation. This study aims to evaluate the effects of ICH on the serum concentration of cytokines as biomarkers of neuroinflammation in an experimental model which isolates ICH from potential confounding variables. Methods: An established model of ICH using an intracerebral pediatric bladder catheter and a multisensor intraparenchymal catheter was used in adult pigs (Sus domesticus). The animals were randomly allocated to 2 groups based on the catheter balloon volume used to simulate the ICP increase (4 ml or 7 ml). Cytokines were measured in 4 timepoints during the experiment: (1) 15 min before balloon insufflation; (2) 5 min after insufflation; (3) 125 min after insufflation; (4) 60 min after deflation. The following cytokines were measured IL-1 alpha; IL-1 beta; IL-1ra; IL-2; IL-4; IL-6; IL-8; IL-10; IL-12; IL-18; TNFa. Generalized estimating equations were modeled to compare the ICP and cytokines values between the groups along the experiment. The study sample size was powered to detect interactions between the groups and the study moments with an effect size (f) of at least 0.3. The ARRIVE checklist was followed. Results: A total of 20 animals were studied (10 in each group, 4 ml or 7 ml balloon volume insufflation). The animal model was successful in increasing the ICP along the moments of the experiment (p < 0,001) and in creating an ICP gradient between the groups (p = 0,004). The interaction term (moment x group) was also significant (p < 0,001). There was a significant association between ICP elevation and most cytokines variation. The cytokines IL-1 alpha, IL-1 beta, IL1-ra, IL-6, IL-12, and IL-18 increased, whereas IL-2, IL-4, and TNF-alpha decreased. IL-10 did not vary significantly in response to the ICP elevation. Conclusion: The serum concentration of cytokines varied in response to intracranial hypertension. The study demonstrated the specific changes in each cytokine afterintracranial hypertension and provides key information to guide neuroinflammation clinical research. The proposed experiment was successful as an animal model to the study of neuroinflammation biomarkers.
- Analysis of Serum Cholesterol, Statins and Atherosclerotic Plaque in Ruptured and Unruptured Intracranial Aneurysm(2022) PIPEK, Leonardo Zumerkorn; RABELO, Nicollas Nunes; PIPEK, Henrique Zumerkorn; TELLES, Joao Paulo Mota; BARBAT, Natalia Camargo; COELHO, Antonio Carlos Samaia da Silva; YOSHIKAWA, Marcia Harumy; BARBOSA, Guilherme Bitencourt; TEIXEIRA, Manoel Jacobsen; FIGUEIREDO, Eberval GadelhaIntroduction Intracranial aneurysm (IA) is a major healthcare concern. The use of statin to reduce serum cholesterol has shown evidence to reduce cardiovascular risk in various diseases, but the impact on IA has not been described. This study aims to determine whether statin use, and serum cholesterol levels interfere with outcomes after IA event. Methods A cohort of patients with IA was analyzed. Patients social and demographics data were collected. Modified Rankin scale (mRS) score after 6 months of follow-up was the endpoint. The data regarding statins use, presence or not of atherosclerotic plaque in radiological images and serum cholesterol of 35 patients were included in our study. Linear regression models were used to determine the influence of those 6 variables in the clinical outcome. Results The prevalence of atherosclerotic plaque, high cholesterol and use of statins was 34.3%, 48.5%, and 14.2%, respectively. Statins and serum cholesterol did not impact the overall outcome, measured by mRS after 6 months ( p > 0.05), but did show different tendencies when separated by IA rupture status. Serum cholesterol shows an important association with rupture of aneurysm ( p = 0.0382). High cholesterol and use of statins show a tendency for worse outcome with ruptured aneurysm, and the opposite is true for unruptured aneurysm. The presence of atherosclerotic plaques was not related with worse outcomes. Conclusions Multiple and opposite mechanisms might be involved in the pathophysiology of IA. Ruptured aneurysms are associated with higher levels of serum cholesterol. Serum cholesterol and statins use were not correlated with worse outcomes, but further studies are important to clarify these relationships.
- Aneurysmal Subarachnoid Hemorrhage: Is the Time Until Intervention Related to Minor Disabilities in 6 Months?(2023) TEBELSKIS, Yuri; RABELO, Nicollas Nunes; PIPEK, Leonardo Zumerkorn; TELLES, Joao Paulo Mota; BARBOSA, Guilherme Bitencourt; BARBAT, Natalia Camargo; COELHO, Antonio Carlos Samaia da Silva; YOSHIKAWA, Marcia Harumy; TEIXEIRA, Manoel Jacobsen; FIGUEIREDO, Eberval GadelhaBackground Aneurysmal subarachnoid hemorrhages (aSAHs) account for 5% of all strokes, an appalling number when it comes to the second most common cause of death worldwide. The basis of the treatment is clinical support and either endovascular or surgical intervention. The purpose of the present study is to analyze if the time from the onset of the thunderclap headache until treatment intervention is related to the degree of disability after 6 months.Methods In the present prospective observational study, data were collected from all patients ( n = 223) admitted to the hospital with a diagnosis of aSAH. Patients whose data were missing or who missed the follow-up after 6 months were excluded. Then, the number of days from the thunderclap headache until the surgical intervention (Delta T) was obtained. The degree of disability was evaluated using standardized scales, Rankin Scale (RS) and Glasgow Outcome Scale (GOS), at the time of discharge as well as 6 months later. Then, the RS and GOS were correlated with Delta T.Results An average of 6.8 days was found from the onset of symptoms to the intervention, the average age was 54 years old, 73% were women and 55% were smokers. The mean Glasgow Coma Scale on admission was 13. The mean score on the Hunt and Hess scale was 2.1. From the radiological point of view, the mean size of the aneurysm was 6 mm, and the modified Fisher Scale was 3.1. Of the total number of patients at the end of the study ( n = 78), 50 underwent microsurgical treatment (63%). Rankin scale at discharge was 1.9 and GOS was 4.5, with no statistically significant change at 6 months. Analyzing the data distribution using linear regression, no statistically significant correlation was found between the time until treatment and disability using RS and GOS ( p > 0.05). The same results were found even analyzing age subgroups (<= 45 years old, 45 to 55 years old, 55 to 70 years old, and > 70 years old with a p -value > 0.05).Conclusions The present study suggests that there is no linear correlation between Delta T and disability at 6 months for the population studied. However, more studies are needed to assess whether these findings may be present in other populations, especially with a shorter time from symptoms to intervention, since the greatest risk of rebleeding occurs in the first 3 days after the event.
- Long-term outcomes of ruptured saccular intracranial aneurysm clipping versus coiling: systematic review and eta-analysis of randomized controlled trials (Apr, 10.1007/s10072-022-06039-2, 2022)(2022) RABELO, Nicollas Nunes; TELLES, Joao Paulo Mota; PIPEK, Leonardo Zumerkorn; MAKAREM, Louise; BOECHAT, Antonio Luis; TEIXEIRA, Manoel Jacobsen; FIGUEIREDO, Eberval Gadelha
- Microsurgery versus embolization: different risk factors for short- and long- term outcomes of patients with ruptured aneurysms(2022) YOSHIKAWA, Marcia Harumy; RABELO, Nicollas Nunes; TELLES, Joao Paulo Mota; BARBOSA, Guilherme Bitencourt; BARBATO, Natalia Camargo; COELHO, Antonio Carlos Samaia da Silva; PIPEK, Leonardo Zumerkorn; TEIXEIRA, Manoel Jacobsen; FIGUEIREDO, Eberval GadelhaPurpose: To evaluate the risk factors for poor outcomes after surgical and endovascular treatment of aneurysmal subarachnoid hemorrhage (aSAH). Methods: Patients with ??? 18-years of age and aSAH were included, while patients who died within 12 h of admission or lost follow-up were excluded. All participants underwent standardized clinical and radiological assessment on admission and were reassessed at discharge and at 6-months follow-up using the Glasgow Outcome Scale (GOS). Results: Death at discharge was associated with female gender, anterior communication artery (ACoA) aneurysm location and presence of atherosclerotic plaque in the surgical group, and with age in the endovascular group. Both groups had clinical condition on follow-up associated with mFisher score on admission and hypertension. GOS on follow-up was also associated with presence of atherosclerotic plaque and multiple aneurysms in surgical group, and with age in endovascular group. Conclusion: Subjects treated surgically are prone to unfavorable outcomes if atherosclerotic plaques and multiple aneurysms are present. In patients with endovascular treatment, age was the main predictor of clinical outcome.